Improving health workforce performance in Ghana, Tanzania and Uganda

The dire shortage of effective, well-performing health workers is a key obstacle to improving health and saving lives in Africa.

The deficit in the health workforce needs to be addressed both by training more new health personnel and improving the performance of the existing and future workforce. A number of complex factors affect workforce performance. Of particular importance are the maldistribution of staff, inappropriate task allocations and a poor working environment.

Understanding the nature of these factors and developing appropriate responses will improve the performance of the existing workforce and reduce staff losses. The project will also increase the effectiveness of future health workers trained and deployed by scaling up initiatives.

Aim & Objectives

The overall aim is to identify ways of strengthening decentralised management to address health workforce inadequacies by improving health workforce performance in sub-Saharan Africa.

The specific objectives are:

  • To support health managers to carry out a situation analysis on the health workforce, with a particular focus on performance, in the study districts.
  • To develop and test context-specific management strengthening processes, focused on improving workforce performance.
  • To conduct comparative analyses across districts and countries of the management strengthening intervention to support improved workforce performance and processes of implementing the integrated human resource and health systems strategies.


Phase one

This preparatory phase is for refining the research approach and developing the methods and instruments to be used in the country case studies and will include selection of study sites.

Phase two

This covers the country studies in Ghana, Tanzania and Uganda and uses an action research methodology. The field work starts with a situation analysis in each of the intervention districts within each country. This is followed by the design of bundles of HR and health system strategies for improving workforce performance. The effects of these strategies will be monitored as part of the action research cycle and where necessary strategies will be revised. Practical aspects of the management strengthening process will be carefully monitored.

Phase three

A comparative analysis of findings across all three countries will provide lessons for national and international audiences.


The main project results will include developed and tested district-level interventions to improve the management of decentralised health systems in the three African countries. These interventions can be potentially replicated in other districts in Ghana, Tanzania and Uganda and in other similar countries.

In addition, the action research approach will contribute to the skills and abilities of participating managers to resolve problems in the future, with the possibility of scaling-up this approach if it proves successful.

Partners & Collaborators

  • Institute of Development Studies, University of Dar-es-salaam, Dar-es-salaam, Tanzania
  • Liverpool School of Tropical Medicine, Liverpool, UK
  • Nuffield Centre for International Health and Development, LIHS, University of Leeds, Leeds, UK
  • School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
  • School of Public Health, University of Ghana, Accra, Ghana
  • Swiss Tropical and Public Health Institute, Basel, Switzerland

Further information

If you would like to speak to a member of the PERFORM team directly, contact Reinhard Huss or Tolib Mirzoev.


The research will contribute to the body of knowledge of how strengthening management in sub-Saharan Africa can improve workforce performance and the wider health system.

Project website